The Death Committee

Prologue

By the time Spurgeon Robinson had been riding the ambulances thirty-six hours on and thirty-six hours off for three weeks, the driver, Meyerson, had long since gotten on his nerves and he was shaken by the gore and troubled by the traumas and didn’t like the duty even a little bit. He found that sometimes he could escape by using his imagination, and on this trip he had just about convinced himself that it wasn’t an ambulance, it was a goddam space ship. He wasn’t an intern, he was the first black man in orbit. The wail of the siren was the jet stream turned into sound.

But Maish Meyerson, the clod, refused to cooperate by acting like a pilot. "Wehr fahrbrent," he snarled at the operator of a stubborn Chrysler convertible, hurling the ambulance around it.

In a city like New York they might have had trouble locating the construction job but in Boston there were still only a few really tall buildings. Because of the red steelmill paint on the naked metal the skeletal structure jabbed into the gray sky like a bloody finger.

It beckoned them right up to the scene of the accident. Spurgeon slammed the door just as the siren whimpered into silence, and the knot of men unraveled around the figure on the ground.

He squatted. The unscathed half of the head told him the patient was a young man. His eyes were closed. A tiny trickle of fluid dripped from the fleshy lobe of one ear.

Somebody three floors up dropped a spanner, a man with a paunch, the foreman, said in answer to the unasked question.

Spurgeon parted the matted hair with his fingers and beneath the lacerated flesh felt the fragments of bone move loose and sharp like bits of shattered eggshell. It was probably cerebrospinal fluid leaking from the ear, he thought. There was no point in trying to debride the injury while the poor guy lay on the ground, he decided, and took a sterile gauze dressing and dropped it on the wound, where it turned red.

The man’s fly was open and his penis was exposed. The fat-bellied foreman saw Spurgeon noticing. He was taking a leak, he said, and Spurgeon could see it, the workingman easing his urgent bladder and gaining wry satisfaction from christening the building he was helping to raise; the wrench falling, falling, falling with unerring accuracy, as if God were remonstrating against dirty little human acts.

The foreman chewed his unlighted cigar and looked at the injured man. His name is Paul Connors. Again and again I’ve told these bastards wear your helmets. Is he going to die?

We can’t tell much from here, Spurgeon said. He lifted a closed eyelid and saw that the pupils were dilated. The pulse was very thready.

The fat man looked at him with suspicion. Are you a doctor?

Black boy?

Yes.

You going to give him something for pain?

He doesn’t feel any pain.

He helped Maish bring out the litter and they loaded Paul Connors into the ambulance.

Hey! the foreman yelled as he started to close the door. I’ll ride with you.

Against the rules, he lied.

I’ve done it before, the man said uncertainly. What hospital are you from?

County General. He pulled at the door and let it slam. Up front, Meyerson started the motor. The ambulance lurched forward. The patient was breathing in shallow gasps, and Spurgeon fixed the black rubber otopharyngeal airway tube in his mouth so it wouldn’t let his tongue interfere and then turned on the respirator. He placed the mask over the patient’s face and the positive pressure oxygen began to be fed in quick short bursts that made noises like a baby burping. The siren gave a small groan of resumption and once more began to unwind a thick ribbon of electronic sound. The ambulance tires whirred against the roadbed. He began to think of how he could orchestrate the incident as a piece of music. Drums, horns, reeds. You could use everything.

Almost everything, he thought as he adjusted the oxygen flow.

You wouldn’t want violins.

Dozing with his head on his arms, Adam Silverstone leaned against the hard desk-top in the Chief Resident’s office and dreamed it was a bed of dry, tight-curled leaves, the accumulation of many past leaf-falls, on which once he had lain as a boy and peered into a quiet brook-pool in the woods. It was in the late spring of the year he was fourteen, a bad time for him because his father had taken to answering his grandmother’s indignant Italian curses with drunken Yiddish insults of his own, and to flee both Myron Silberstein and the old vecchia he had simply taken to the highway one Saturday morning and traveled three hours by thumb, without destination, heading only away from the smoke and grit of Pittsburgh and what it represented, until he was dropped off by a motorist on a section of road which ran through woods. Later he had tried half a dozen times to find the place, but he could never remember exactly where it had been, or perhaps by the time he had gotten back to it the forest had been raped by a bulldozer and had spawned houses. Not that it had been anything special; the woods were sparse and scraggly with fallen trees, the trickle of a stream had never housed a trout, the pool was a deep clear puddle. But the water was cold and sun-dappled. He had stretched out on his stomach in the leaves, smelling the odors of cool forest mold, his stomach beginning to feel hunger, conscious of the fact that soon he would have to begin hitch-hiking back, but caring about nothing as he lay and watched little Jesus-bugs walking on the water. What had he experienced in the half hour he had stayed—before the insistent spring dampness crept up through the dry leaves and made him take his shivering leave—that would cause him to dream of the little pool for the rest of his life?

Peace, he decided years later.

That peace was shattered now by the ringing of the telephone, which, still asleep, he answered.

Adam? Spurgeon.

Yo, he said, yawning.

We may have a kidney donor, pal.

He was less sleepy. Yeah?

I just brought a patient in. Compound depressed skull fracture with lots of brain damage. Meomartino’s assisting Harold Poole with the neurosurgery right now. He said for me to tell you the EEG showed no electrical activity at all.

Now he was wide awake.

What’s the patient’s blood type? he said.

AB.

Susan Garland is AB. That means this kidney goes to Susan Garland.

Ah—Meomartino says to tell you the patient’s mother is in the waiting room. The name is Connors.

Goddammit. The task of securing legal permission for transplantation was left to the Chief Resident and the Surgical Fellow. Invariably, he had noticed, Meomartino, the Fellow, was busy with other urgent duties when it came time to talk with the next-of-kin. I’ll be right down, he said.

Mrs. Connors was sitting with her pastor, only slightly prepared by the fact that her son had been given Extreme Unction. She was a life-worn woman with a talent for disbelief.

"Ah, don’t be telling me something like that, she said, with filled eyes and a tremulous smile, as if she could reason him out of the entire thing. He isn’t, she insisted. He isn’t dying. Not my Paullie."

She was technically correct, Adam thought. By that time, to all intents and purposes, her boy was already dead. The Boston Edison Company was keeping him breathing. Once the electric respirator was switched off, within twenty minutes he would be gone entirely.

He could never tell them he was sorry; it was so inadequate.

She began to weep, achingly.

He waited the long interval until she had regained some control and then as gently as possible he explained about Susan Garland. Do you understand about the little girl? She’ll die, too, unless we give her another kidney.

Poor lamb, she said.

He didn’t know whether she meant her son or the girl.

Then you would sign the permission slip?

He’s been torn up enough. But if it will save some other mother’s child . . .

We hope that it will, Adam said. The permission secured, he thanked her and fled.

Our Lord gave up his entire body for you and for me, he heard the priest say as he walked away. For Paul, too, for that matter.

I never said I was Mary, Father, the woman said.

Depressed, he felt it would help his spirits to see the opposite side of the coin.

In Room 308 Bonita Garland, Susan’s mother, sat in a chair and knitted. As usual when the girl saw him from her bed she pulled the sheet up to her neck over nightgowned acorn-breasts, a gesture he carefully refrained from noticing. She was propped against two pillows and reading Mad, which somehow relieved him. Weeks earlier during a long sleepless night when she was hooked up to the splashing dialysis machine that periodically washed her blood free of the poisons accumulated because of her ruined kidneys, he had seen her leafing through Seventeen and had teased her about reading the magazine when she was scarcely fourteen herself.

I wanted to be certain I got to it, she had said, turning a page.

Now, ebullient with good news, he stood at the foot of her bed. Hi, luv, he said. She was going through a fervent emotional involvement with English musical groups, an infatuation to which he prostituted himself shamelessly. I know a girl says I look like the character who’s always on the cover of that magazine. What’s his name?

Alfred E. Neumann?

Yeah.

You’re ever so much better looking. She cocked her head to look at him and he saw that the dark rings had deepened under her eyes and that her face was thinner, with pain-lines around the nose. When first he had seen the face it had been vibrant and impish. Now, even though the freckles showed starkly against the sallowing skin, still it was a face that promised great adult attractiveness.

Thank you, he said. You’d better be careful about paying me compliments. Howard might come after me. Howard was her boy friend. They were forbidden by her parents to go steady, she had confided to Adam one night, but they went steady anyway. Sometimes she read him portions of Howard’s letters.

He knew she was trying to make him jealous of Howard and was touched and flattered.

He’s coming to see me this weekend.

Why don’t you ask him to make it next weekend, instead?

She stared at him, alerted by the chronic patient’s invisible warning system. Why?

You’ll have good news for him. We have a kidney for you.

Oh, God. Bonita Garland’s eyes were exultant. She set down her knitting and looked at her daughter.

I don’t want it, Susan said. Her thin fingers bent the covers of the magazine.

Why not? Adam asked.

You don’t know what you’re saying, Susan, her mother said. We’ve been waiting so long for this.

I’ve become used to things the way they are. I know what to expect.

No, you don’t, he said gently. He took her fingers away from the magazine and held them between his hands. Unless we operate things will become worse. Much worse. After we operate, things will be better. No more headaches. No more nights spent hooked up to the damn machine. In a little while you can go back to school. You can go to dances with Howard.

She closed her eyes. Will you promise me nothing will go wrong?

Jesus. He saw her mother, smiling with painful understanding, nod at him.

Of course, he said.

Bonita Garland went to the girl and took her in her arms. Darling, it’s going to be just fine. You’ll see.

Momma.

Bonita pressed her daughter’s head to her breast and began to rock. Susie-Q, she said. Oh, thank God, we’re lucky people.

Momma, I am just so scared.

Don’t you be silly. You heard Dr. Silverstone give his word.

He went out of the room and walked downstairs. Neither of them had asked where the kidney was coming from. Next time he saw them, he knew, they would feel ashamed about that.

Outside the hospital there was still traffic but it was thinning. The air blew in from the sea and over the dirtiest part of the city, carrying a rich mixture of smells, most of them bad. He felt like swimming twenty fast laps or making prolonged love, some activity frenziedly physical that might lighten the weight pushing him into the concrete. If he were anything but the son of a drunkard he would have gone to a bar. Instead he walked across the street to Maxie’s and had canned chowder and two cups of black coffee. There wasn’t a damn thing the kid behind the counter could do to or for the chowder. The coffee was like a first kiss from an ugly girl, nothing to brag about but comforting.

The Surgical Fellow, Meomartino, had established the lines of communication between the Operating Rooms and the donor’s next-of-kin. You had to hand it to him, the system worked, Adam Silverstone thought grudgingly as he scrubbed away at his nails.

Spurgeon Robinson was stationed at the door of OR-3.

Upstairs, in the surgical office on the first floor, another intern named Jack Moylan waited with Mrs. Connors. In Moylan’s pocket was a slip giving permission for autopsy. He sat with the telephone receiver held to his ear, listening for something to come over the silent open line. At the other end of the line was a first-year resident named Mike Schneider, who sat behind the desk in the corridor outside the OR door.

Ten feet from where Spurgeon stood and watched and waited, Paul Connors lay on the table. It was more than twenty-four hours since he had been brought into the hospital, but the respirator still breathed for him. Meomartino already had prepped him and placed a sterile plastic drape over the abdominal area.

Near him Dr. Kender, the Associate Chief of Surgery, talked softly with Dr. Arthur Williamson of the Department of Medicine.

At the same time in adjoining OR-4, Adam Silverstone, by now scrubbed and gowned, walked to the operating table on which Susan Garland lay. The girl, sedated, stared at him sleepily, not recognizing him behind the surgical mask.

Hi, luv, he said.

Oh. You.

How you doing?

Everybody in sheets. You’re all so weird. She smiled, and closed her eyes.

At 7:55 in OR-3 Dr. Kender and Dr. Williamson placed the electrodes of an electroencephalograph on Paul Connors’ skull.

As it had on the previous evening, the EEG’s stylus drew a straight line on the graph paper, confirming their knowledge that his mind was not alive. Twice in twenty-four hours they had recorded the absence of electrical activity in the patient’s brain. His pupils were widely dilated and they found no peripheral reflexes.

At 7:59 Dr. Kender turned off the respirator. Almost at once, Paul Connors ceased to breathe.

At 8:16 Dr. Williamson checked for a heart-beat and, finding none, declared him to be dead.

Immediately, Spurgeon Robinson opened the door leading to the corridor. Right now, he said to Mike Schneider.

He’s gone, Schneider said into the telephone.

They waited in silence. In a very little while Schneider listened intently and then turned from the telephone.

She signed it, he said.

Spurgeon went back into OR-3 and nodded to Meomartino. While Dr. Kender watched, the Surgical Fellow picked up a scalpel and made the transverse incision which would allow him to remove the kidney from the cadaver.

Meomartino worked with extreme care, aware that his nephrectomy was clean and right because of Dr. Kender’s approving silence. He was accustomed to operating before the judging eyes of senior men and was never upset by them.

Still, his self-assurance cracked for a split second when he looked up and saw Dr. Longwood seated in the gallery.

Was it the shadows? Or in his moment of observation were the puffy dark signs of uremic poisoning already discernible beneath the Old Man’s eyes?

Dr. Kender cleared his throat and Meomartino bent over the cadaver again.

It took him only sixteen minutes to remove the kidney, which appeared to be a good one, with a single, well-defined artery. While he searched the abdomen with gloved fingers to make sure no occult tumor was present, the communications team, each member by now scrubbed and waiting, took the freed kidney and hooked it to a perfusion system which pumped icy-cold fluids through the organ.

Before their eyes the big red bean of flesh whitened as the blood was washed out of it, and shrank with cold.

They carried the kidney to OR-4 on a tray and Adam Silverstone assisted as Dr. Kender made it part of the girl’s body and then removed both of her own kidneys, wasted and wrinkled bits of spoiled tissue that had not functioned for a long time. Even so, as Adam dropped the second one from the forceps to the towel he was newly aware that now Susan Garland’s only lifeline was the artery joining her blood supply to Paul Connors’ kidney. By that time the transplanted organ was already pinking healthily, warmed by the rush of her young blood.

Less than half an hour after the transplant was begun, Adam closed the abdominal incision. He helped the orderly move Susan Garland to the sterile recovery room and so he was the last man to get to the junior surgeons’ room. Robinson and Schneider already had changed from OR greens to whites and had returned to the wards. Meomartino was in his underwear.

It looked like a score, Meomartino said.

Adam held up crossed fingers.

Did you see Longwood?

No. The Old Man was there?

Meomartino nodded.

Adam opened the metal locker which contained his own whites and began to pull off the black non-static OR boots.

I don’t know why he would want to watch, Meomartino said in a little while.

He’ll be getting one himself, soon, if we’re lucky enough to get a B-negative donor.

That’s not going to be easy. B-negatives are rare.

Adam shrugged. I suppose Mrs. Bergstrom will get the next transplant, he conceded.

Don’t be so sure.

One of the infuriating things about the relationship between the Fellow and the Chief Resident was that when one of them received information which hadn’t reached the other, it was difficult to resist the temptation to act as if he had a direct pipeline to God. Adam rolled the green scrub suit into a ball and tossed it into the half-filled laundry basket in the corner. What the hell is that supposed to mean? Bergstrom will get a kidney from her twin, right?

The sister isn’t sure she wants to give one away.

Jesus. He pulled his whites from the locker and climbed into the trousers which, he noted, were becoming grimy and would have to be replaced with a fresh pair for the next day.

Meomartino left as he was tying his shoes. Adam wanted a cigarette, but the little electronic monster in his lapel pocket sounded its soft snarl and when he phoned in he learned that Susan Garland’s father was waiting to see him, so he went straight up.

Arthur Garland was in his early but fattening forties, with uncertain blue eyes and a receding auburn hairline. A leather-goods distributor, Adam remembered.

I didn’t want to leave without talking with you.

I’m just a house officer. Perhaps you should talk with Dr. Kender.

I just talked with Dr. Kender. He said everything went as well as could be expected.

Adam nodded.

Bonnie—my wife—insisted I see you. She said you’ve been understanding. I wanted to say thanks.

There’s no need. How is Mrs. Garland?

I sent her home. This has been very difficult, and Dr. Kender said we won’t be able to see Susan for a couple of days.

The less contact she has, even with people who love her, the less likely she is to pick up infection. The drugs we’re using to keep her body from rejecting the new kidney also weaken her resistance.

I understand, Garland said. Dr. Silverstone, does everything look all right?

He was sure that Garland had already asked Dr. Kender. Faced with the man’s need for a positive portent, a cabalistic sign to certify that all was under perfect control, he was acutely aware of their real impotence.

The surgery went smoothly, he said. It was a good kidney. We have a lot going for us.

What do you do next?

Watch her.

Garland nodded. A small token. He took a wallet from his pocket. Alligator. My company handles the line.

Adam was embarrassed.

"I gave one to Dr. Kender, too. Don’t presume to thank me, you people are giving me back my girl." The trapped blue eyes became shiny, swam, spilled over. Ashamed, the man looked away, at the blank wall.

Mr. Garland, you’re tired as hell. If you don’t mind my saying so, why don’t you let me give you a prescription for a sedative and then go home?

Yes. Please. He blew his nose. Do you have children of your own?

Adam shook his head.

You shouldn’t miss the experience. We adopted her, you know?

Yes. Yes, I do.

I fought with Bonnie about that. For five years. I was ashamed. But then we finally got her, six weeks old . . . Garland took the prescription, started to say something else, shook his head and walked away.

The transplant had been done on Friday. By the following Wednesday Adam felt in his bones that they were home free.

Susan Garland’s blood pressure was still high, but the kidney was functioning as though custom-designed.

I never thought my heart would pound because somebody called for a bedpan, Bonita Garland told him.

It would be a while yet before her daughter could be comfortable. The incision bothered her and she was weakened by the drugs they administered to keep her system from rejecting the kidney. She was depressed. She snapped at well-meant remarks and she wept at night. On Thursday she brightened during a visit from Howard, who turned out to be a skinny boy, painfully shy.

It was Howard’s effect on her that gave Adam the idea.

Who’s her favorite radio disc jockey?

I think J. J. Johnson, her mother said.

Why don’t you call him and ask him to dedicate some numbers to her on Saturday night? We can invite Howard to visit her. She won’t be able to dance or even leave her bed, but under the circumstances it might be an acceptable substitute.

You should be a psychiatrist, Mrs. Garland said.

"My private dance? Susan said when they told her about it. My hair’s got to be washed. It’s grubby." Her mood changed so drastically that, by now carried away, Silverstone telephoned and ordered a corsage, spending for red roses money he had earmarked for other purposes, and dictating a card:

Have a ball, luv.

On Friday her morale was good but it dropped as evening approached. When Adam came by on rounds he found that she had listed several complaints with the nurse.

What’s the matter, Susie?

I ache.

Where?

All over. My stomach.

You’ve got to expect a little of that. After all, you’ve had a major operation. He knew that you could fall into the trap of over-coddling. He checked the surgical wound, which was unremarkable. Her pulse rate was up a little, but when he cuffed her arm and took her blood pressure he grinned in satisfaction. Normal. For the first time. How do you like them apples?

Good. She smiled faintly.

You get some sleep, now, so you can enjoy your dance tomorrow night.

She nodded and he hurried away.

It was six hours later that the floor nurse, coming into her room with medication, discovered that in her sleep the girl had bled to death internally during the quiet hours of the night.

Dr. Longwood wants the Garland case discussed at the next meeting of the Death Committee, Meomartino said over lunch the next day.

I don’t think that’s fair, Adam said.

They were sitting with Spurgeon Robinson at a table next to the wall. He was toying with the horrible stew the hospital served every Saturday. Spurgeon ate his apathetically while Meomartino virtually shoveled it away. How the hell had the cliché evolved which insisted that the rich had sensitive stomachs, Adam asked himself.

Why not?

Kidney transplantation is barely out of the experimental stages. How can we try to affix responsibility for death in an area over which we still don’t have a hell of a lot of control?

That’s the point, Meomartino said calmly, wiping his mouth. "It is beyond the experimental stage. Hospitals all over the country are doing this operation with success. If we’re going to use it clinically, we have to take responsibility for it."

He could talk that way, Adam thought; the only role he had played in this case had been in removing the kidney from the cadaver.

She looked perfectly well when you saw her last night? Spurgeon Robinson asked.

Adam nodded and glanced at the intern sharply. Then he forced himself to relax; Spurgeon, unlike Meomartino, had no ax to grind.

I don’t think Dr. Longwood should be allowed to chair that meeting, Robinson said. He’s not a well man. He runs those Mortality Conferences as if they’re the Inquisition and he’s Torquemada.

Meomartino grinned. His health doesn’t have a damn thing to do with it. The old bastard has always run the Death Conference that way.

They could tear a man’s prospects to shreds in one of those meetings, Adam thought. He put down his fork and pushed his chair back.

Tell me something, he said to Meomartino, feeling the sudden need to be contentious. You’re the only one on the Service who never refers to Longwood as the Old Man. Is the term too disrespectful for you?

Meomartino smiled. On the contrary. It is simply that I believe the term to be one of affection, he said quietly. And went on eating with unabated enjoyment.

Just before he went off duty that night he remembered about the rose corsage.

Flowers? Yes, they came, Dr. Silverstone, the nurse at the desk said. I had them sent on to the Garland home. It’s what we always do.

Have a ball, luv . . .

I could at least have spared them that, he thought.

It’s all right, isn’t it?

Sure.

He went up to the little room on the sixth floor and sat and smoked four cigarettes without enjoyment, one after the other, and found himself biting his nails, a habit he’d believed broken long ago.

He thought of his father, from whom he had not heard, wondered about trying to phone him in Pittsburgh and then decided with relief to leave well enough alone.

After a long while he left the room and went downstairs and outside to the deserted street. Maxie’s was closed and black. The street lamps made a path through the dark like tracer bullets, interrupted halfway down the block where probably kids had stoned a bulb.

He started to walk.

Then he started to run.

Down to the corner, feeling the concrete sidewalk slam up against his feet.

Around the corner.

On the avenue, moving faster.

A car burred by, the horn hooted, a female shouted something and tittered. In his chest he felt the small choked feeling surge and he ran faster despite the stitch of pain that bubbled to life in his right side.

Around the corner.

Past the ambulance yard. Empty. The green-painted tin shade of the huge yellow light over the ambulance entrance fluttering in the night breeze, telegraphing dancing shadows as he pounded alongside.

Past the loading platform of the warehouse next door where a derelict—seen fleetingly in the dark as a form, a blob, an umbra, his father—drained the last drops from a pint and then sent the empty bottle sailing through the unknown after him as he sped, arms pumping now, chased by a backache and the tinkling crash of broken glass.

Round the corner.

Into the darkest stretch, the back of the moon. Past the blank-eyed houses of the blank-eyed colored slum across the street, mercifully asleep.

Past the parked car where the writhing figures did not break their beat but the girl peered over her lover’s shoulder and through the glass at the spectral boneshaker galloping by.

Past the alley where the noise of his feet frightened something small and alive, clawed nails skittering on the hard-packed earth as it fled deeper into the tunnel.

Around the corner.

The street lamps again. His lungs burning, unable to breathe, his head back, a sticking pain in the chest, straining to break the tape as no crowd stood and screamed, he reached Maxie’s, staggered and stopped.

Jesus.

He gulped air, swallowed air, knew he was going to be sick, belched loudly and knew he was not.

He was damp under the arms and between the legs, his face was wet. A fool. Panting, he leaned against Maxie’s window, which creaked ominously, slid down on it until his buttocks rested on the little red-painted wooden ledge that supported the plate glass.

The ledge gritted beneath him. To hell with it, the whites were already dirty.

He threw back his head and looked up at the starless sky.

They have no right to pray to me, he said. Why don’t they ask you for promises?

He dropped the trajectory of his sight a few degrees and he knew the presence of the building only a little lower than heaven, saw the old red brick that had been browned by the dirt and smoke of the city grown around it, felt the stupid patience of the scarred facade.

He remembered the first time he had seen the hospital, only a few months and thousands of years ago.

Book One

The Summer

1

Adam Silverstone

The stars had slowly squeezed into hiding in the bleaching sky. As the asthmatic truck left the Massachusetts Turnpike and chugged through the deserted outskirts, the long line of street lamps bordering the river flickered twice and then died in the gloom. The hot day was coming, but the loss of the line of lights ahead gave a brief, deceptive chill and gloom to the daybreak.

He stared through the dusty windshield as Boston approached, thinking that this was the city that had shaped his father, broken him and ground him down.

You’re not going to do that to me, he told the passing buildings, the skyline, the river.

It doesn’t look like such a tough town, he said.

The truck driver looked at him in surprise. Their conversation had unraveled its way into tired silence eighty miles back, between Hartford and Worcester, following a tight, terse disagreement over the John Birch Society. Now the man said something indistinct which was lost against the thrum of the truck’s motor.

Adam shook his head. I’m sorry. I didn’t understand you.

What’s the matter, you deaf?

A little. Just in my left ear.

The man frowned, suspecting mockery. I said, you got a job waiting?

Adam nodded.

Doing what?

I’m a surgeon.

The driver looked at him in disgust, confident now that his suspicions were justified. Sure, you beatnik punk. I’m an astronaut.

He opened his mouth to explain and then thought to hell with him and shut it again and concentrated on the scenery. Poking up through the murk on the other side of the Charles River he could see white spires, undoubtedly Harvard. Somewhere over there was Radcliffe College and Gaby Pender sleeping like a pussycat, he thought, wondering how long he could wait before he called her. Would she remember him? A quotation came to his mind uninvited—something about how often a man needs to see a woman—that once is sufficient, but twice may confirm it.

Within his head the little computer told him who was the author of the lines. As usual, the ability to remember a non-medical reference filled him with bilious discontent instead of pride. A waster of words, he could hear his father say. Adamo Roberto Silverstone, you smug bastard, he told himself, see where the gift of memory is when you’re struggling with something from Thorek’s Anatomy in Surgery or Wangensteen’s Intestinal Obstruction.

In a little while the man swung the wheel and the truck lumbered off Storrow Drive and down a ramp and suddenly there were lighted warehouse windows, trucks, cars, people, a market district. The driver tooled the van down one street of cobblestones, past a diner whose neon still flashed, and up another long cobblestoned street, stopping before BENJ. MORETTI & SONS PRODUCE. In answer to his horn a man emerged and peered at them from the loading platform. Beefy and balding, in his white smock he looked not unlike one of the pathologists at the Georgia hospital where Adam had taken his internship and first year of residency. Eh, paisan.

What you got?

The driver belched, a sound like carpet ripping. Melons. Persians. The man in white nodded and disappeared.

End of the line, kid. The driver opened the door and climbed heavily down from the cab.

Adam reached behind the seat, took up the worn valpak and joined the other man on the ground. Can I help you unload?

The driver scowled at him with suspicion. "They do it, he said, jerking his head toward the warehouse. You want a job, you ask them."

The offer had been made out of gratitude, but Adam saw with relief that it was unnecessary. Thanks for the lift, he said.

Yuh.

He carried the suitcase back down the street to the diner, struggling with it, a small bandy-legged man, too big for a jockey, not enough heft for most other sports except diving, which for him had ceased to be a sport five years before. It was at times like this that he regretted not resembling more closely his mother’s brawny brothers. He disliked being at the mercy of anyone or anything, including a piece of luggage.

Inside there were wildly enticing food smells and mad diner noise: talk and laughter, the hollow clatter of panware through the small window leading to the kitchen, the solid sound of coffee mugs against the white marble counter, things sizzling on the grill. Expensive things, he decided.

Coffee, black.

Bleed one, the straw-haired girl said. She was full-blown and firm fleshed, with pale and milky skin; but she would have an obesity problem before she was thirty. Under her white-draped left breast twin smears of red jam stood out like stigmata. The coffee slopped over the rim of the mug as she pushed it toward him, accepted his dime sullenly and swung away with an insult of hips.

Moo.

The coffee was very hot and he drank it slowly, now and then gulping with great daring and feeling victorious when it became clear that he had not burned his tongue. The wall behind the counter was mirrored. Staring back at him from it was a bum, stubble-faced, wild-haired, wearing a soiled and worn blue work-shirt. When he finished the coffee he got up and carried the suitcase into the men’s room. He tested the faucets; both the HOT and the COLD ran cool, a circumstance that failed to surprise him. He went back into the diner and asked the girl for a cup of very hot water.

For soup or for tea?

Just for water.

With an air of patient disgust she ignored him. Finally he surrendered and ordered tea. When it came he paid for it and took the teabag from the saucer and dropped it on the counter. He carried the cup of hot water into the men’s room. The floor was covered with layers of grit and, judging from the odor, dried urine. He set the cup on the edge of the dirty sink and, balancing the suitcase on the radiator, opened it to remove his toilet articles. By collecting cold water from the tap in his cupped palm and adding hot water from the cup